Open heart surgery — whether for a valve replacement, an artery bypass, or another reason — is a big undertaking. Typically, patients are supported from preparation through stages of healing by close family and friends. Recovery after open heart surgery begins right away, in the intensive care unit (ICU). If you are a loved one of a heart surgery patient, you may be able to see him or her as early as one or two hours after surgery in the ICU. Are you prepared for what the immediate post-op visit and hospital stay will be like?
Most of the time spent with the heart specialist team ahead of surgery focuses on early preparations, like x-rays and lab tests, or what the patient is and is not allowed to do in the weeks afterward. Caregivers are encouraged to join in these talks, but the focus usually is about how to support the patient at home—not how to reassure scared family or friends when they see their loved ones the first time after surgery and have stepped into a full-time caregiving position. If you are one of those loved ones, you’re probably anxious and scared, just like the patient is. And you might be surprised by what the patient faces to earn a hospital discharge.
Too many tubes
After surgery, your first visit to the patient can be startling: she or he may still be heavily sedated with a large breathing tube — called an endotracheal tube — down the throat. Because of the risk of groggy patients pulling on the tube, straps may be holding the patient’s wrists to the bed loosely, too.
As your loved one wakens, you may be present when the tube is removed (quickly pulled out with a hard cough); this is the first step to leaving the ICU and continuing on the recovery pathway. But this doesn’t mean that your loved one is talking yet.
Besides the throat tube, other tubes and wires are attached all over the body:
- A catheter (type of IV) into the neck
- Two to four drainage tubes in the middle of the chest below the sternum
- Four pacing wires that exit the body near the drainage tubes and are taped to the skin
- Many sensors to check breathing, heart rate, temperature, blood pressure, and more around the clock. Especially in the early hours after surgery, blood pressure will be watched very carefully in case it goes too high or too low.
Finger pricks and IV lines
You may have seen an IV (intravenous) line before or had your own blood drawn from a vein for physical exams. After surgery, your loved one will have many IV lines going into both arms and even a wrist in addition to all of the tubes. The hospital will try to keep the number of IVs as low as possible.
Some IV lines carry fluids to help maintain the right blood pressure, and the line into the wrist artery measures pressure constantly for extra safety.
Other IV lines provide important vitamins and nutrients depleted during surgery; some have medicines like blood pressure treatments, antibiotics, or insulin. Frequent finger pricks to check blood sugar changes after surgery make sure that the right amount of insulin is given.
Swelling, oozing, and bruising
Like other surgeries, heart surgery causes patients to swell from extra fluids given during surgery. The puffiness might startle you at first, but the swelling (called edema) goes down as the patient moves around more.
It is normal for the incisions to ooze and drain, too. The amount of fluid coming out of the drainage tubes will change as the patient becomes more active: increasing at first and then slowing as recovery continues. These tubes are pulled out before discharge, and the area might continue to be tender for a few weeks. The large catheter in the neck also is removed within a few days after surgery, and pressure is applied to stop bleeding quickly. Removal of the pacing wires is the last hurdle before discharge for most patients. The wires are attached directly to the heart’s chambers, in case an arrhythmia develops right after surgery.
Bruising is one possible side effect of the tubes, wires, and stitches that comes with open heart surgery. The amount of bruising differs for every patient, and colors range from yellow to dark grey or purple. Although bruising at the incision, tube openings, and IV areas might look scary, it also fades quickly as the patient is more active and as the lines and tubes are removed.
When your loved one is finally ready to go home after open heart surgery, you too will have seen and learned a lot about hospital stays and how the body begins to heal itself.
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